Ergot given prior to delivery produces a frightful mortality among infants, and is the most frequent cause of retention of the placenta, as well as of other ab normal conditions. It is never necessary except hypodermically in dangerous post-palm hmuorrhage in rare cases. J. W. Hyde (Amer. Med. Digest, Apr. 15, 'SS).
Ergot injections found invaluable in external haemorrhage due to uterine in ertia in labor. Ch. Liegeois (Revue Gen. de Clin et de Ther. Jour. des Prat., June 22, '95).
The conditions and circumstances tin der which ergot may be employed in obstetrics are (1) that the presentation may be natural or cranial, except in some instances of breech presentation, in which it may be necessary to deal at once with uterine inertia; (2) that there should be no marked disproportion be tween the froths and mother, or any other physical impediment in the genital tract to delivery; (3) that the os uteri, if not previously fully dilated, should be so dilatable as to allow speedy extrac tion by the forceps when necessary; and (4) that the preparation selected, the (lose, and the method in which it is em ployed, should be well calculated to pro duce the required effect.
Subject to these conditions, ergot may, with utility, be employed when actually indicated and judiciously administered either before, during, or after the second stage of labor. That is to say, it may be given before the full dilatation of a dilatable os, (1) in sonic instances of long delay from uterine inertia in which there is imminent danger to mother or child, or (2) risk of subsequent flooding from further protraction of the case. During the second stage it may be em ployed (3) in labor rendered abnormally tedious by deficiency of uterine action or otherwise complicated, and in which the presentation is natural and no other im pediments to delivery exist; or (4) for the prophylaxis of apparently impending flooding. During the third stage ergot may be resorted to (5) for the expulsion of the placenta when retained by inertia, or (6) for the arrest of loss of blood. After delivery this ecbolic may be em ployed either immediately (7) to check or prevent hemorrhage, or subsequently (S) to produce tonic or permanent con traction; or it may be exhibited (9) for the purpose of expelling clots from the womb and so arresting after-pains. Last, (10) in the majority of multip arous patients ergot may be adminis tered during the puerperal period, with the object of stimulating the muscular tonicity of the uterus. Thomas More Madden (Lancet, May 29, '97).
Small doses, 10 minims of the fluid extract repeated hourly, as suggested by Wood, may serve to intensify the pains of a slow labor or incite them in uterine inertia. Instrumental delivery, however, is generally preferred to the use of ergot. The proper time for the exhibition of ergot is generally conceded to be at the end of the third stage—after the delivery of the child and the placenta—when it aids in producing a firm, lasting con traction of the uterus. It is especially
indicated if an anesthetic has been re quired to effect delivery. It is useful as a prophylactic against, and a remedy for, post-partem haemorrhage.
Cornutin in inertia uteri, during par turition, cannot be recommended as ef fectual. It is of especial value in atonic postpartum hemorrhage, and in the limmorrhage following an abortion. It also acts promptly in the metrorrhagia and menorrhagia that occur in conse quence of endometritis, metritis, or other diseases of the uterus or its ad nexa, and can be given hypodermic ally in doses of V„ to grain, or to grain, internally. A solution usually gets milky in from eight to four teen days, and it is then useless. In jurious effects never noticed. H. Thomp son (Centralb. f. Gynak., Mar. 16, '89).
Cornutin has not proved reliable in a number of cases where it was used to control uterine haemorrhages due to atony of the muscles after confinement, and in other gynaecological troubles. The effect of ergotine is persistent, and in every way is superior to cornutin. Editorial (Wiener klin. Woch., Nos. 22 and 23, '95).
AB0RT10NS.—Ergot is here useful if the uterus remains relaxed, but is contra indicated before the uterus has been emptied. It is useful in the subinvolu tion consequent upon abortions, given continually in small doses.
ILEMORRHAGE.—Ergot is used in hmmorrhagia dependent upon the pres ence of fibroids or other neoplasms. It was used formerly to cause shrinkage of uterine fibroids, but surgical methods are now more in favor.
In the treatment of uterine fibroids by the injection of fresh, pure solutions of ergotine the needle should be inserted for not more than to i/, of an inch into the anterior or posterior lip, but never into the body of the uterus or into the tumor itself. Schiicking (Centralb. f. Gyidik., Feb. 25, 'SS).
Indications for ergotinol are the same as for ergot. Maximum dose used, 30 minims daily. In case of fibroma with excessive menorrhagia, one injection daily for eight days during the men strual epoch given with excellent re sults. M. Abel (Med. and Surg. • Re porter, June 5, '97).
In pulmonary haemorrhage its use is not advised, because of the increased vascular tension which it produces. For the same reason it is not advised in cerebral apoplexy. On other forms of hmmorrhage, however, it is a valuable haemostatic: in epistaxis, in hrematuria (renal or vesical), in purpura rhagia, the haemorrhage of scurvy, etc.
It has been used also in the intestinal haemorrhage of typhoid, in dysentery with bloody stools, in serous diarrhwa, and in bleeding hemorrhoids. DIABETEs.—The use of ergot com bined with the bromide of sodium is vised by Hare in the treatment of dia betes insipidus.